An Overview of Cor Pulmonale

A.K.A. Right-Sided Heart Failure

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Cor pulmonale occurs when blood pressure in the pulmonary artery—which carries blood from the heart to the lungs—increases and leads to the enlargement and subsequent failure of the right side of the heart. It can be a complication of several lung conditions including, chronic obstructive pulmonary disease (COPD), and pulmonary embolism.

Symptoms of cor pulmonale tend to align with those of its cause (e.g., wheezing with COPD), but may become more telling over time. Cor pulmonale is a progressive condition that can sometimes get worse rapidly. If left untreated, it may be life-threatening.

Causes

The left side of the heart is responsible for pumping blood to the entire body. Because of the extent of this job, it requires a significant amount of blood pressure to do it. In contrast, the right side of the heart requires much lower blood pressure, as it only pumps blood through the lungs.

Pulmonary hypertension occurs when the pressure in the right side of the heart is higher than it should be. (The term pulmonary relates specifically to the lungs.)

The right ventricle pumps blood to the lungs; the right atrium receives blood return from the heart. Any condition that leads to pulmonary hypertension can put a strain on these chambers of the heart. When they fail or are unable to work against the abnormally high pressure within the lungs, cor pulmonale occurs.

While COPD is a common cause of cor pulmonale, other possible causes include:

  • Cystic fibrosis
  • Sleep apnea
  • Scleroderma of the lungs
  • Blood clots in the lungs (pulmonary embolism)
  • Lung tissue damage
  • Acute respiratory distress syndrome (ARDS)
  • Interstitial lung disease (ILD)

Symptoms

The symptoms of cor pulmonale are normally related to the underlying lung disease and can include:

  • Shortness of breath (dyspnea)
  • Wheezing and coughing
  • Swelling of the feet and/or ankles
  • Pronounced neck veins
  • Inability to tolerate exercise
  • Chest pains
  • Bluish tinge to your skin, nail bed, lips, or gums (cyanosis)

Pulmonary hypertension and cor pulmonale can lead to severe fluid retention which, in turn, can cause life-threatening dyspnea, shock, and even death.

Diagnosis

The initial diagnosis for cor pulmonale is usually made in the doctor’s office. A physical exam typically picks up any abnormal heartbeats, fluid retention, or protruding neck veins that may be indicative of pulmonary hypertension.

To provide a definitive diagnosis, the doctor may also perform the following tests:

  • Echocardiogram, which uses sound waves to visualize the heart
  • Chest X-ray
  • Computerized tomography (CT) scan of the chest
  • Arterial blood gases (ABG) blood test
  • Pulmonary artery catheterization, the insertion of a catheter into the pulmonary artery to check for heart failure
  • Ventilation/perfusion scan, the use of radioactive materials to examine the airflow and blood flow into the lung

Treatment

Treatment for cor pulmonale is focused on addressing the underlying illness. With regard to COPD and other lung disorders, the options may include:

  • Oxygen therapy to increase the oxygen level in the bloodstream
  • In very select cases, Calcium channel blockers, which prevent calcium from entering cells of the heart and blood vessel walls, thereby lowering blood pressure
  • Anticoagulants (blood thinners), which are known to decrease mortality in persons with pulmonary hypertension
  • Possibly a heart or lung transplant in very advanced cases

Treatment with oxygen, medications, and/or surgery can result in an improvement of symptoms, greater energy, and oftentimes a longer survival time.

Since COPD is a leading cause of cor pulmonale, quitting smoking can help slow the progression of COPD and may prevent cor pulmonale from happening.

A Word From Verywell

Do your best to keep your blood pressure under control and follow a healthy lifestyle, which incorporates regular gentle exercise, plenty of hydration, and a balanced diet. Taking care of your body, especially if you have a pre-existing lung condition, can go a long way in preventing further complications.

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